I have been on all three sides of the issue discussed, at the refereing facility, at the receiving facility, and on the transport. Blanket discussions of transport priorities should not be based upon team makeup, though, I tend to doubt that an attending physician rides on many transports.
In some cases, ECMO fellows will go along for the ride, just because the child may require ECMO, though, since they are not doing the cannulations, nor were we transporting with running ECMO circuits, I am not sure what they offered the patient.
In one case, I can recall transporting from a Level III NICU to an ECMO center, with a child whose PaO2 was in the 40's. (For those of you not familiar with NICU terminology, they work the exact opposite of trauma certifications, where a Level I NICU MIGHT keep a child on oxygen....) We chose to do the 90 second flight by helicopter, because it was much shorter than the 20 min emergency transport by ground. (No, the child did not survive, but Group B Strep sepsis is pretty deadly....)
Another case was a cardiac baby (either Tetralogy of Fallot or Transposition of the Great Vessels, I don't remember,) who had a heart rate of 250 which we could not convert, and shocking a <750g infant was not on our list of things we wanted to do to the child. As we did not have rotor wing transport available at the time, we opted to do the 60 mile transport with the aid of traffic clearance devices. (That child survived to discharge, and should be in her mid teens by now.)
Back to my original contention. Second guessing transport priorities based upon the presence or absence of team members with varying levels of medical license is rather closed minded.
